Method for generating a registered image relative to a cardiac cycle and a respiratory cycle of a person

ABSTRACT

A method for generating a registered image relative to a cardiac cycle and a respiratory cycle of a person is provided. The method includes generating a plurality of 2-D images of an anatomical region of the person. The method further includes generating a 3-D model of the anatomical region of the person. The 3-D model is associated with a predetermined phase of the cardiac cycle and a predetermined phase of the respiratory cycle. The method further includes selecting a first 2-D image from the plurality of 2-D images associated with the predetermined phase of the cardiac cycle and the predetermined phase of the respiratory cycle. The method further includes generating the registered image of the anatomical region utilizing the first 2-D image and the 3-D model. The method further includes storing the registered image in a memory device.

CROSS REFERENCE TO RELATED APPLICATIONS

The application claims the benefit of U.S. Provisional application Ser.No. 60/855,115, filed Oct. 30, 2006, the contents of which areincorporated herein by reference thereto.

BACKGROUND OF THE INVENTION

A fluoroscopy system has been utilized to generate a 2-D image of ananatomical region. Further, a CT system has been utilized to generate a3-D model an anatomical region. However, a drawback associated with thefluoroscopy system and the CT system, is that neither system cangenerate a registered image, illustrating features of the anatomicalregion in the 2-D image and the 3-D model, corresponding to apredetermined phase of a cardiac cycle and a predetermined phase of arespiratory cycle.

The inventors herein have recognized a need for a method for generatinga registered image of an anatomical region that is associated with apredetermined phase of a cardiac cycle and a predetermined phase of arespiratory cycle.

BRIEF DESCRIPTION OF THE INVENTION

A method for generating a registered image relative to a cardiac cycleand a respiratory cycle of a person in accordance with an exemplaryembodiment is provided. The method includes generating a plurality of2-D images of an anatomical region of the person. The method furtherincludes generating a 3-D model of the anatomical region of the person.The 3-D model is associated with a predetermined phase of the cardiaccycle and a predetermined phase of the respiratory cycle. The methodfurther includes selecting a first 2-D image from the plurality of 2-Dimages associated with the predetermined phase of the cardiac cycle andthe predetermined phase of the respiratory cycle. The method furtherincludes generating the registered image of the anatomical regionutilizing the first 2-D image and the 3-D model. The method furtherincludes storing the registered image in a memory device.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic of a system for displaying a location of a pointof interest on a 3-D model of an anatomical region and for generating aregistered image relative to a cardiac cycle and a respiratory cycle ofa person in accordance with an exemplary embodiment;

FIG. 2 is a block diagram of a method for generating a registered image;

FIG. 3 is a block diagram of another method for generating a registeredimage;

FIG. 4 is a block diagram of a method for generating a registered imageutilizing a 2-D image and a 3-D model having similar orientations;

FIG. 5 is a schematic of a 2-D image having an antero-posterior view ofa heart;

FIG. 6 is a schematic of a 3-D model of a heart;

FIG. 7 is a schematic of a registered image generated from the 2-D imageof FIG. 5 and the 3-D model of FIG. 6;

FIG. 8 is a block diagram of a method for generating a registered imageutilizing cardiac gating and respiratory gating;

FIG. 9 is a schematic of an exemplary ECG signal;

FIG. 10 is another schematic of an exemplary ECG signal;

FIG. 11 is a schematic of 2-D image of a catheter in a heart duringexpiration by a person;

FIG. 12 is a schematic of 2-D image of a catheter in a heart duringinspiration by a person;

FIG. 13 is a block diagram illustrating a respiratory monitoring systemmonitoring a phase of a respiratory cycle utilizing 2-D images;

FIG. 14 is a schematic of a 2-D image of a heart obtained at apredetermined phase of the cardiac cycle in a predetermined phase of arespiratory cycle;

FIG. 15 is a schematic of a registered image of the heart generated bythe 2-D image of FIG. 14 and a 3-D model;

FIG. 16 is a flowchart of a method for generating a registered image inaccordance with another exemplary embodiment;

FIGS. 17-18 are flowcharts of a method for displaying a location of apoint of interest on a 3-D model of an anatomical region of a person inaccordance with another exemplary embodiment;

FIG. 19 is a schematic of exemplary 2-images and a 3-model utilized inthe method of FIGS. 17-18;

FIGS. 20-22 are flowcharts of a method for displaying a location of apoint of interest on a 3-D model of an anatomical region of a person inaccordance with another exemplary embodiment;

FIG. 23 is a schematic of exemplary 2-images and a 3-model utilized inthe method of FIGS. 20-22;

FIGS. 24-25 are flowcharts of a method for displaying a location of apoint of interest on a 3-D model of an anatomical region of a person inaccordance with another exemplary embodiment;

FIG. 26 is a schematic of an exemplary 2-image and a 3-model utilized inthe method of FIGS. 24-25;

FIGS. 27-31 are flowcharts of a method for displaying a location of apoint of interest on a 3-D model of an anatomical region of a person;

FIG. 32 is a schematic of a graphical user interface for identifying alocation of the point of interest on a 3-D model of an anatomical regionof a person;

FIG. 33 is a schematic of a registered image having marked electricalactivation sites;

FIG. 34 is a schematic of another registered image having markedelectrical activation sites; and

FIG. 35 is a schematic of a registered image having marked voltagegeneration sites.

DETAILED DESCRIPTION OF THE INVENTION

Referring to FIG. 1, a schematic of a system 20 for displaying alocation of a point of interest on a 3-D model of an anatomical regionand for generating a registered image in accordance with an exemplaryembodiment is illustrated. The system 20 includes a computed tomography(CT) image acquisition system 22, a fluoroscopy image acquisition system24, a heart monitoring system 26, a respiratory monitoring system 28, acatheter control system 30, and ablation-mapping catheter 32, areference catheter 34, a catheter position monitoring system 36, aregistration computer 38, a memory device 40, a display device 42, andan input device 44.

The CT image acquisition system 22 is provided to generate a 3-D modelof the anatomical region of a person 66. The CT image acquisition system22 includes a CT scanning device 60, a CT image acquisition computer 62,and a table 64. The CT scanning device 60 generates scanning data of theanatomical region of the person 66 who is disposed on the table 64. TheCT scanning device 60 transfers the scanning data to the CT imageacquisition computer 62. Thereafter, the CT image acquisition computer62 generates a 3-D model of the anatomical region of the person 66 basedon the scanning data. Further, the CT image acquisition computer 62 cantransfer the 3-D model of the anatomical region to the registrationcomputer 38. The CT image acquisition computer 62 operably communicateswith the registration computer 38 and the fluoroscopy image acquisitioncomputer 82. It should be noted that in alternative embodiments, othertypes of systems other than the CT image acquisition system 22 can beutilized to generate 3-D models of the anatomical region. For example,in alternative embodiments, a magnetic resonance imaging (MRI) imageacquisition system or an ultrasonic image acquisition system could beutilized to generate a 3-D model of the anatomical region.

The fluoroscopy image acquisition system 24 is provided to generate aplurality of 2-D images of the anatomical region of a person 66. In oneexemplary embodiment, the fluoroscopy image acquisition system 24 cangenerate a 2-D image of the anatomical region during a predeterminedphase of the cardiac cycle and a predetermined phase of a respiratorycycle, based on a control signal from the registration computer 38. Thefluoroscopy image acquisition system 24 includes an X-ray source 80, anX-ray detector 81, a fluoroscopy image acquisition computer 82, and afluoroscopy paddle 84. When the fluoroscopy paddle 84 is depressed byoperator, the X-ray source 80 generates X-rays that propagate throughthe anatomical region of the person 66. The X-ray detector 81 detectsthe X-rays that have propagated through the person 66 and generates datathat is transferred to the fluoroscopy image acquisition computer 82.The fluoroscopy image acquisition computer 82 generates 2-D images ofthe anatomical region utilizing the data from the X-ray detector 81. Inone exemplary embodiment, the fluoroscopy image acquisition computer 82generates 2-D images of the anatomical region in response to a controlsignal received from the registration computer 38 indicating that theperson has a predetermined phase of a cardiac cycle and predeterminedphase of a respiratory cycle. The fluoroscopy image acquisition computer82 can transfer the 2-D images of the anatomical region to theregistration computer 38. The fluoroscopy image acquisition computer 82operably communicates with the registration computer 38, the fluoroscopypaddle 84, the X-ray source 80, the X-ray detector 81, and therespiratory monitoring system 28.

It should be noted that the inventors herein have recognized a computersystem can more accurately locate a point of interest on a 3-D model ofan anatomical region, utilizing one or more points selected on one ormore 2-D images of the anatomical region, when the 3-D model and the 2-Dimages correspond to a predetermined phase of a cardiac cycle and apredetermined phase of a respiratory cycle.

Referring to FIGS. 1 and 9, the heart monitoring system 26 is providedto generate an ECG signal indicative of a cardiac cycle of the person66. The registration computer 38 can utilize an ECG signal 220 toinstruct the fluoroscopy image acquisition computer 82 to generate 2-Dimages when the heart has a predetermined phase of a cardiac cycle,which is referred to as cardiac gating. Alternately, the registrationcomputer 38 can utilize intracardiac electrograms obtained from thecatheters such as the coronary sinus catheter positioned inside of theheart, to instruct the fluoroscopy image acquisition computer 82 togenerate 2-D images when the heart has a predetermined phase of acardiac cycle. As shown, the ECG signal 220 has a QRS complex portion222 and an atrial diastole portion 223 (i.e., relaxation phase of theheart).

In one exemplary embodiment, the fluoroscopy image acquisition system 24generates 2-D images of the anatomical region when the ECG signal 220indicates a cardiac phase range of 55-60% of the cardiac cycle. Inanother exemplary embodiment, the fluoroscopy image acquisition system24 generates 2-D images of the anatomical region when the ECG signal 220indicates a ventricular diastole (i.e., a cardiac phase range of 70-75%of the cardiac cycle). Of course, other cardiac phases or phase rangescould be utilized by the fluoroscopy image acquisition system 24 togenerate 2-D images.

Referring to FIG. 9, a priori technique for determining a time forgenerating 2-D images during a predetermined phase of a cardiac cyclewill be explained. Initially, the ECG signal 220 is monitored forseveral heart beats (e.g., 10 heart beats). Thereafter, an average rateof these beats is calculated to determine the next time interval in thepriori technique. Further, an R wave is calculated and a degree ofprematurity is also taken into account. For example, any beat within 50%of the average period of the beats is considered premature and ignored.In case of irregular rhythm such as atrial fibrillation this evaluationis ignored. An ECG trigger timer (shown by an arrow in FIG. 9) isstarted when an amplitude of the ECG signal 220 at the QRS complexportion is greater than a predetermined amplitude. The leading (rising)edge of the QRS complex portion 222 is a positive slope and trailing(falling) edge of the QRS complex portion 222 is a negative slope. It isnoted that the priori method prevents acquisition of a 2-D image on a Twave. Further, a refractory time period, such as 200-300 millisecondsfor example, is determined when the trailing edge of the QRS complexportion 222 is less than the threshold amplitude. During the refractoryperiod, the fluoroscopy image acquisition computer 82 does not generatenew 2-D images. As illustrated, the ECG signal 220 represents an averageR-R interval of 10 heart beats was 1000 milliseconds (60 beats) perminute. In this example, when the ECG trigger timer measures 550milliseconds, a heart is at the 55% phase of the cardiac cycle.Alternately, when the ECG trigger timer measures 750 milliseconds, aheart is at the 75% phase of the cardiac cycle.

Referring to FIG. 10, a post priori technique can also be utilized todetermine a time for generating 2-D images during a predetermined phaseof a cardiac cycle. In particular, a preceding heart beat is selectedand either a 55% phase or a 75% phase of the cardiac cycle is determinedbased on the preceding heart beat.

Referring to FIG. 1, the respiratory monitoring system 28 is provided todetermine a phase of a respiratory cycle of the person 66. Therespiratory monitoring system utilizes 2-D images generated by thefluoroscopy image acquisition system 24 to determine a phase of therespiratory cycle, as will be explained below. The registration computer38 can utilize data representing the phase of the respiratory cycle fromthe respiratory monitoring system 28 to instruct the fluoroscopy imageacquisition computer 82 to generate 2-D images during a predeterminedphase of the respiratory cycle, which is referred to as respiratorygating.

Referring to FIGS. 11 and 12, a brief overview of the methodologyutilized by the respiratory monitoring system 28 for determining a phaseof a respiratory cycle will now be provided. FIG. 11 corresponds to a2-D image 230 obtained from the fluoroscopy image acquisition system 24during an expiration phase of a respiratory cycle. The 2-D image 230illustrates a coronary sinus catheter 242 and a diaphragm 240 disposedin a heart of a person. As shown, the coronary sinus catheter 242 andthe diaphragm 240 are disposed at a maximum upward position indicatingan expiration phase of the respiratory cycle of the person. Accordingly,the respiratory monitoring system 28 can utilize the position of thecoronary sinus catheter 242 and the diaphragm 240 in the 2-D image 232to determine that an expiration phase of the respiratory cycle isdetected. FIG. 12 corresponds to a 2-D image 260 obtained from thefluoroscopy image acquisition system 24 during an inspiration phase of arespiratory cycle. The 2-D image 230 illustrates the coronary sinuscatheter 242 and the diaphragm 240 disposed in a heart of a person. Asshown, the coronary sinus catheter 242 and the diaphragm 240 aredisposed at a maximum downward position indicating an inspiration phaseof the respiratory cycle of the person. Accordingly, the respiratorymonitoring system 28 can utilize the position of the coronary sinuscatheter 242 and the diaphragm 240 in the 2-D image 260 to determinethat an inspiration phase of the respiratory cycle is detected. In analternative embodiment, other devices or tools in the heart other thanthe coronary sinus catheter 242 and diaphragm 240 could be utilized todetermine a phase of a respiratory cycle. Further, in alternativeembodiments, other techniques known to those skilled in the art could beutilized to determine a phase of a respiratory cycle.

Referring to FIG. 13, during operation in one exemplary embodiment, therespiratory monitoring system 28 receives 2-D images 280, 282, 284, 286from the fluoroscopy image acquisition system 24 over a respiratorycycle of a person. By detecting a position of catheters in the 2-Dimages 280, 282, 284, 286, the respiratory monitoring system 28 candetermine the phase of a respiratory cycle. Further, the respiratorymonitoring system 28 communicates data corresponding to the phase of therespiratory cycle to the registration computer 38.

Another method for obtaining a 2-D image utilizing the fluoroscopy imageacquisition system 24 will now be explained. The method includesmonitoring cardiac cycles of a person. The method further includesmonitoring an operational position of the fluoroscopy paddle 84,utilizing the fluoroscopy image acquisition computer 82. The methodfurther includes generating the 2-D image of an anatomical region of theperson when a predetermined phase of the cardiac cycle exists and anoperational position of the fluoroscopy paddle 84 is a predeterminedoperational position, utilizing the fluoroscopy image acquisitioncomputer 82. The method further includes storing the 2-D image in amemory device, utilizing the fluoroscopy image acquisition computer 82.

Referring to FIG. 1, the catheter control system 30 is provided tocontrol operation of the ablation-mapping catheter 32 and to receivesignals from the ablation-mapping catheter 32 and the reference catheter34. During operation, the catheter control system 30 sends controlsignals to the ablation-mapping catheter 32 to induce theablation-mapping catheter 32 to perform ablation procedures on theheart.

The ablation-mapping catheter 32 and the reference catheter 34 are alsoprovided to monitor electrical activity in a heart of a person. Inparticular, the ablation-mapping catheter 32 detects an amplitude of anelectrical signal in the heart at a position of the ablation-mappingcatheter 32. Further, the ablation-mapping catheter 32 sends a signal tocatheter control system 30 indicative of the amplitude of the electricalsignal detected by the ablation-mapping catheter 32. Theablation-mapping catheter 32 further includes a position sensor 90 thatgenerates a signal indicative of a position of the catheter 32 in theanatomical region. The reference catheter 34 also detects an amplitudeof an electrical signal in the heart at a position of the referencecatheter 34. Further, the reference catheter 34 sends a signal tocatheter control system 30 indicative of the amplitude of the electricalsignal detected by the reference catheter 34.

The catheter position monitoring system 36 is provided to monitor aposition of the ablation-mapping catheter 32 with respect to acoordinate system of the catheter position monitoring system 36. In oneexemplary embodiment, the catheter position monitoring system 36generates a fluctuating magnetic field that is detected by the sensor 90in the ablation-mapping catheter 32. In one exemplary embodiment, thesensor 90 generates a signal responsive to the fluctuating magneticfield that is sent to the catheter control system 30. The cathetercontrol system 30 sends data corresponding to the signal from the sensor92 the catheter position monitoring system 36. The catheter positionmonitoring system 36 determines the position of the ablation-mappingcatheter 32 with respect to the coordinate system of the system 36,based on the data received from the catheter control system 30. Further,the catheter position monitoring system 36 sends data corresponding tothe position of the ablation mapping catheter 32 in the coordinatesystem of the system 36, to the registration computer 38.

The registration computer 38 is provided to induce the display device 42to display a location of a point of interest on a 3-D model of ananatomical region, as will be explained in further detail below. Theregistration computer 38 is further provided to generate a registeredimage of the anatomical region utilizing the 3-D model of the anatomicalregion and a 2-D image of the anatomical region, as will be explained infurther detail below. The registration computer 38 operably communicateswith the fluoroscopy image acquisition computer 82, the CT imageacquisition computer 62, the heart monitoring system 26, the cathetercontrol system 30, the catheter position monitoring system 36, thememory device 40, the display device 42, and the input device 44. Theinput device 44 allows the user to input data utilized by theregistration computer 38. In one exemplary embodiment, the input device44 comprises a computer keyboard. In another exemplary embodiment, theinput device 44 comprises a computer mouse. The registration computer 38is configured to induce the display device to display a graphical userinterface for allowing the user to view 2-D images, 3-D models, andregistered images. The registration computer 38 is further configured tostore data, such as 2-D images, 3-D models, and registered images in thememory device 40.

For purposes of understanding, a general overview of a process forgenerating a registered image will now be provided. A registered imageis generated by combining information from a 2-D image of an anatomicalregion and a 3-D model of the anatomical region. Registration is theprocess of aligning images and 3-D models to generate a registeredimage. Intra-subject multi-modality registration is registration of twodifferent modalities in the same person. The number of parameters neededto describe a transformation (registration) is referred herein as numberof “degrees of freedom.” Assumption is made that the 3-D model behavesas a rigid body, as the anatomy of the anatomical region beingregistered has not changed significantly. In this case, threetranslations and three rotations, which gives six degrees of freedom,will lead to successful registration. Each device used for registrationis calibrated to approximate the size of the 3-D model of the anatomicalregion. This requires three extra degrees of freedom equating to“scaling” in each direction. If a set of corresponding anatomicallandmarks (fiducials) x and y can be a defined, then the registrationcan be affected by selecting a transformation matrix that will alignthese areas. Each view in the device being used is being referred to asthe coordinate system that will define a space in that view. Successfulregistration involves the determination of a transformation matrixbetween the individuals in one space (X) of one view, for example withthat of another space (Y), for example. Successful registration willinvolve determination of a transformation matrix T between for thefiducials in the “X” space with those in the “Y” space that minimizesthe error (T(x)−y, where T(x)=Ry+t, wherein R is the rotation, and t isthe translation.

A transformation matrix defines how to map points from one coordinatesystem into another coordinate system. By identifying contents of thetransformation matrix, several operations including projectivetransformation, rotation, translation and scaling, between a 2-D imageof an anatomical region and a 3-D model of the anatomical region can beperformed. In particular, the 2-D image of the anatomical region can berotated, translated, and scaled (depending if a parallel or conicprojection is performed) relative to the 3-D model of the anatomicalregion. Thereafter, the registered image can be obtained by overlayingthe projected, rotated, translated, and scaled 2-D image of theanatomical region on the 3-D model of the anatomical region.

In one exemplary embodiment, instead of aligning an anatomical region ina 2-D image with the anatomical region in a 3-D model, registration isperformed by aligning in the 2-D image and the 3-D model, a tool placedby a physician in the anatomical region. For example, a catheter placedin the coronary sinus of a heart can be utilized to align a 2-D image ofthe heart and a 3-D model of the heart.

A detailed discussion of techniques for obtaining registered images,which can be utilized herein, is discussed in U.S. patent applicationSer. No. 10/964,428, entitled “Method And Apparatus For Registering 3DModels of Anatomical Regions Of A Heart And A Tracking System WithProjection images Of An Interventional Fluoroscopic System”, filed onOct. 13, 2004, which is incorporated by reference herein; and U.S.patent application Ser. No. 10/964,429, entitled “Method And System ForRegistering 3D models Of Anatomical Regions With Projection Images OfThe Same”, filed on Oct. 13, 2004, which is incorporated by referenceherein.

Referring to FIGS. 1 and 2, a brief explanation of a sequentialgeneration of registered images will be provided. As shown, a 3-D modelof an anatomical region, such a 3-D model of a left atrium of a heartfor example, is transferred from the CT image acquisition computer 62 tothe registration computer 38. When the fluoroscopy paddle 84 isdepressed at a first-time, a 2-D image 102 of the anatomical region,such a left atrium of a heart for example, is transferred to theregistration computer 38. Thereafter, the registration computer 38generates a registered image 104 based upon the 3-D model 100 and the2-D image 102. When the fluoroscopy paddle 84 is depressed at a secondtime, a 2-D image 106 of the anatomical region such a left atrium of aheart for example, is transferred to the registration computer 38.Thereafter, the registration computer 38 generates a registered image108 based upon the 3-D model 100 and the 2-D image 106.

Referring to FIG. 3, a brief explanation of another technique forsequentially generating registered images will be provided. As shown, a3-D model 121 is stored in the registration computer 38. When thefluoroscopy paddle 84 is depressed at a first time, a 2-D image 118 ofthe anatomical region such a left atrium of a heart for example, istransferred to the registration computer 38. Thereafter, theregistration computer 38 generates a registered image 122 based upon the3-D model 121 and the 2-D image 118. When the fluoroscopy paddle 84 isdepressed at a second time, a 2-D image 120 of the anatomical regionsuch a left atrium of a heart for example, is transferred to theregistration computer 38. Thereafter, the registration computer 38generates another registered image based upon the 3-D model 121 and the2-D image 120.

Referring to FIGS. 4-7, a technique for obtaining a similar orientationof 2-D image of an anatomical region and a 3-D image of anatomicalregion will be explained. In this example, the anatomical region is ahuman heart. As shown, a fluoroscopy X-ray detector 81 is orientated toobtain an antero-posterior (AP) orientation of the heart. Thefluoroscopy image acquisition computer 82 generates a 2-D image 130 ofthe heart having an AP orientation and sends the 2-D image 132 to theregistration computer 38. The fluoroscopy image acquisition computer 82further sends data to the CT image acquisition computer 62 indicating anAP orientation is desired. The CT image acquisition computer 62generates a 3-D model 132 of the heart having an AP orientation andsends the 3-D model 132 to the registration computer 38. Thus, theregistration computer 38 receives a 2-D image and a 3-D model having asimilar orientation. Thereafter, the registration computer 38 generatesa registered image 134 with an AP orientation based on the 2-D image 130and the 3-D model 132. As shown, the 2-D image 130 illustrates anantero-posterior orientation of the heart having a sinus catheter 152,and ablation mapping catheter 154, and a multi-electrode basket catheter156. Further, the registered image illustrates an antero-posteriororientation of the heart including the sinus catheter 152, the ablationmapping catheter 154 and the multi electrode basket catheter 156.

Referring to FIG. 8, a brief description of a technique for obtaining aregistered image of an anatomical region having a predetermined phase ofa cardiac cycle and a predetermined phase of a respiration cycle will bedescribed. As shown, the fluoroscopy image acquisition computer 82generates: (i) a 2-D image 200 at a 25% phase of a cardiac cycle and afull expiration phase of a respiratory cycle, (ii) a 2-D image 202 at a50% phase of the cardiac cycle and the full expiration phase of therespiratory cycle, (iii) a 2-D image 204 at a 75% phase of the cardiaccycle and the full expiration phase of the respiratory cycle, and (iv) a2-D image 206 at a 100% phase of the cardiac cycle and the fullexpiration phase of the respiration cycle. Thereafter, the registrationcomputer 38 selects the 2-D image 204 at a 75% phase of the cardiaccycle and the full expiration phase of the respiratory cycle,corresponding to the 3-D model 208 having a 75% phase of the cardiaccycle and the full expiration phase of the respiratory cycle.Thereafter, the registration computer 38 generates a registered image210 based on the 2-D image 204 and the 3-D model 208.

Referring to FIGS. 14 and 15, a 2-D image 300 of a heart and a 3-D model310 of the heart is illustrated. The 2-D image 300 and a 3-D model ofthe heart having a similar phase of a cardiac cycle and a similar phaseof a respiratory cycle were utilized to generate the registered image310. As shown, both the 2-D image 300 and the registered image 310illustrate a multi-electrode basket catheter 302 in the heart.

Referring to FIG. 16, a flowchart of a method for generating aregistered image utilizing cardiac gating and respiratory gating willnow be explained.

At step 320, the heart monitoring system 26 monitors cardiac cycles of aperson.

At step 322, the respiratory monitoring system monitors respiratorycycles of the person.

At step 324, the fluoroscopy image acquisition system 24 generates aplurality of 2-D images of an anatomical region of the person.

At step 326, the CT image acquisition system 22 generates a 3-D model ofthe anatomical region of the person. The 3-D model is associated with apredetermined phase of a cardiac cycle and a predetermined phase of arespiratory cycle.

At step 328, the computer 38 selects a first 2-D image from theplurality of 2-D images associated with the predetermined phase of thecardiac cycle and the predetermined phase of the respiratory cycle. Thecomputer 38 operably communicates with the heart monitoring system 26,the respiratory monitoring system 28, the fluoroscopy image acquisitionsystem 24, and the CT image acquisition system 22.

At step 330, the computer 38 generates a registered image utilizing thefirst 2-D image and the 3-D model.

At step 332, the computer 38 induces the display device 42 to displaythe registered image.

At step 334, the computer 38 stores the registered image in the memorydevice 40.

Referring to FIGS. 17-19, a flowchart of a method for displaying alocation of a point of interest on a 3-D model of anatomical region of aperson in accordance with an exemplary embodiment will now be explained.

At step 350, the fluoroscopy image acquisition system 24 generates afirst 2-D image 390 of the anatomical region when the X-ray source 80 ofthe fluoroscopy image acquisition system 24 is disposed at a firstposition 396 in a 3-D coordinate system of the fluoroscopy imageacquisition system 24. The first 2-D image 390 indicates a catheter orany other object of interest disposed in the anatomical region.

At step 352, that computer 38 induces the display device 42 to displaythe first 2-D image 390. The computer 38 operably communicates with thefluoroscopy image acquisition system 24, the display device 42, and theinput device 44.

At step 354, a user selects a first point 394 on the first 2-D image 390utilizing the input device 44 operably communicating with the displaydevice 42. The first point 394 is in a 2-D coordinate system of thefirst 2-D image 390. The first point 394 corresponds to a portion of thecatheter disposed in the anatomical region.

At step 356, the computer 38 determines a first projection line 395extending from the first point 394 to the first position 396 of theX-ray source 80 in the 3-D coordinate system of the fluoroscopy imageacquisition system 24.

At step 358, the fluoroscopy image acquisition system 24 generates asecond 2-D image 392 of the anatomical region when the X-ray source 80of the fluoroscopy image acquisition system 24 is disposed at a secondposition 400 in the 3-D coordinate system of the fluoroscopy imageacquisition system 24. The second 2-D image 392 indicates the catheterdisposed in the anatomical region.

At step 360, the computer 38 induces the display device 42 to displaythe second 2-D image 392.

At step 362, a user selects a second point 398 on the second 2-D image392 utilizing the input device 44. The second point 398 is in a 2-Dcoordinate system of the second 2-D image 398. The second point 398corresponds to a portion of the catheter disposed in the anatomicalregion.

At step 364, the computer 38 determines a second projection line 399extending from the second point 398 to the second position 400 of theX-ray source 80 in the 3-D coordinate system of the fluoroscopy imageacquisition system 24.

At step 366, the computer 38 determines the point of interest 401 in thecoordinate system of the fluoroscopy image acquisition system 24 thatcorresponds to an intersection point of the first and second projectionlines 395, 399.

At step 368, the computer 38 determines a position of the point ofinterest 401 in a 3-D coordinate system of a 3-D model 400 of theanatomical region, utilizing a transformation matrix. Two projectiveequations that have two transformation matrices utilized to calculatethe position of the point of interest 401 are as follows:

$\begin{pmatrix}{su}_{1} \\{sv}_{1} \\s\end{pmatrix} = {P_{1}\begin{pmatrix}X \\Y \\Z \\1\end{pmatrix}}$ ${{and}\begin{pmatrix}{su}_{2} \\{sv}_{2} \\s\end{pmatrix}} = {P_{2}\begin{pmatrix}X \\Y \\Z \\1\end{pmatrix}}$In the first equation, the terms u₁, v₁ correspond to the u, vcoordinates of the point 394 in the coordinate system of the 2-D image390. The terms X, Y, Z in the first equation correspond to the point ofinterest 401 in the coordinate system of the 3-D model 400. The term P₁corresponds to a transformation matrix to transform the coordinates inthe 2-D image 390 to the coordinate system of the 3-D model 400. In thesecond equation, the terms u₂, v₂ correspond to the u, v coordinates ofthe point 398 in the 2-D image 392. The terms X, Y, Z in the secondequation correspond to the point of interest 401 in the coordinatesystem of the 3-D model 400. The term P₂ corresponds to a transformationmatrix to transform the coordinates in the 2-D image 392 to thecoordinate system of the 3-D model 400. By solving these two equations,the coordinates X, Y, Z of the point of interest 401 in the coordinatesystem of the 3-D model 400 can be determined.

At step 370, the computer 38 attaches a marking icon at the point ofinterest 401 in the 3-D model 400 of the anatomical region. At step 372,the computer 38 induces the display device 42 to display the 3-D model400 of the anatomical region having the marking icon indicating theposition of the point of interest 401.

At step 374, the computer 38 stores the 3-D model 400 with the markingicon in the memory device 40.

Referring to FIGS. 20-23, a flowchart of a method for displaying alocation of a point of interest on a 3-D model of anatomical region of aperson in accordance with another exemplary embodiment will now beexplained.

At step 410, the fluoroscopy image acquisition system 24 generates afirst 2-D image 450 of an anatomical region, when the X-ray source 80 ofthe fluoroscopy image acquisition system 24 is disposed at a firstposition 460 in a 3-D coordinate system of a 3-D model 454 of theanatomical region. The first 2-D image 450 indicates a catheter or anyother object of interest disposed in the anatomical region.

At step 412, the computer 38 induces the display device 42 to displaythe first 2-D image 450. The computer 38 operably communicates with thefluoroscopy image acquisition system 24, the display device 42, and theinput device 44.

At step 414, a user selects a first point 452 on the first 2-D image 450utilizing the input device 44 operably communicating with the displaydevice 42. The first point 452 is in a 2-D coordinate system of thefirst 2-D image 450. The first point 452 corresponds to a portion of thecatheter disposed in the anatomical region.

At step 416, the computer 38 projects the 3-D model 454 in a firstprojection direction to obtain a first projected image 456.

At step 418, the computer 38 determines a second point 458 on the firstprojected image 456 corresponding to the first point 452 on the first2-D image 450, utilizing a first transformation matrix to obtain anin-plane alignment between the first 2-D image 450 and the firstprojected image 456.

At step 420, the computer 38 determines a first projection line 462extending from the second point 458 to the first position 460 of theX-ray source 80 in the 3-D coordinate system of the 3-D model 454.

At step 422, the fluoroscopy image acquisition system 24 generates asecond 2-D image 470 of the anatomical region, when the X-ray source 80of the fluoroscopy image acquisition system 24 is disposed at a secondposition 478 in the 3-D coordinate system of the 3-D model 454. Thesecond 2-D image 470 indicates the catheter disposed in the anatomicalregion.

At step 424, the computer 38 induces the display device 42 to displaythe second 2-D image 470.

At step 426, a user selects a third point 472 on the second 2-D image470 of the anatomical region utilizing the input device 44. The thirdpoint 472 is in a 2-D coordinate system of the second 2-D image 470. Thethird point 472 corresponds to a portion of the catheter disposed in theanatomical region.

At step 428, the computer 38 projects the 3-D model 454 in a secondprojection direction to obtain a second projected image 474.

At step 430, the computer 38 determines a fourth point 476 on the secondprojected image 474 corresponding to the third point 472 on the second2-D image 470, utilizing a second transformation matrix to obtain anin-plane alignment between the second 2-D image 470 and the secondprojected image 474.

At step 432, the computer 38 determines a second projection line 480extending from the second point 476 to the second position 478 of theX-ray source 80 in the 3-D coordinate system of the 3-D model 454.

At step 434, the computer 38 determines the point of interest 482 in the3-D coordinate system of the 3-D model 454 that corresponds to anintersection point of the first and second projection lines 462, 480.

At step 436, the computer 38 attaches a marking icon at the point ofinterest 482 in the 3-D model 454 of the anatomical region.

At step 438, the computer 38 induces the display device 42 to displaythe 3-D model 454 of the anatomical region having the marking icon atthe position of the point of interest 482.

At step 440, the computer 38 stores the 3-D model 454 with the markingicon in the memory device 40.

Referring to FIGS. 24-26, a flowchart of a method for displaying alocation of a point of interest on a 3-D model of anatomical region of aperson in accordance with another exemplary embodiment will now beexplained.

At step 500, the fluoroscopy image acquisition system 24 generates a 2-Dimage 540 of an anatomical region when the X-ray source 80 of thefluoroscopy image acquisition system 24 is disposed at a first position546 in a 3-D coordinate system of a 3-D model 542 of the anatomicalregion. The 2-D image 540 indicates a catheter disposed in theanatomical region.

At step 502, the computer 38 induces the display device 42 to displaythe 2-D image 540. The computer 38 operably communicates with thefluoroscopy image acquisition system 24, the display device 42, and theinput device 44.

At step 504, a user selects a point 544 on the 2-D image 540 utilizingthe input device 44 operably communicating with the display device 42.The point 544 is in a 2-D coordinate system of the 2-D image 540. Thepoint 544 corresponds to a portion of the catheter disposed in theanatomical region.

At step 506, the computer 38 determines a first projection line 550extending from the point 544 on the 2-D image 540 to the first position546 of the X-ray source 80 in the 3-D coordinate system of the 3-D model542.

At step 508, the computer 38 determines at least first and second points552, 554 on the 3-D model 542 where the first projection line 550intersects an outer surface of the 3-D model 550.

At step 510, the computer 38 makes a determination as to whether a userdesires to select one of first and second points 552, 554. If the valueof step 510 equals “yes”, the method advances to step 512. Otherwise,the method advances to step 516.

At step 512, the computer 38 induces the display device 42 to displaythe 3-D model 542 with first and second marking icons disposed at thefirst and second points 552, 554, respectively. After step 512, themethod advances to step 514.

At step 514, the user selects one of the first and second marking iconsat the first and second points 552, 554, respectively, representing thelocation of the point of interest. After step 514, the method advancesto step 522.

Referring again to step 510, if the value of step 510 equals “no”, themethod advances to step 516. At step 516, the computer 38 makes adetermination as to whether the user desires automatic selection of oneof first and second points 552, 554. If the value of step 516 equals“yes”, the method advances to step 518. Otherwise, the method returns tostep 500.

At step 518, the catheter position monitoring system 36 monitors alocation of a portion of the catheter in the anatomical region. Afterstep 518, the method advances to step 520.

At step 520, the computer 38 selects one of the first and second points552, 554 on the 3-D model 542 of the anatomical region, based on themonitored location of the portion of the catheter in the anatomicalregion. After step 520, the method advances to step 522.

As discussed above, after step 514 or step 520, the method advances tostep 522. At step 522, the computer 38 attaches a marking icon at theselected one of the first and second points 552, 554 representing thelocation of the point of interest in the 3-D model 542 of the anatomicalregion.

At step 524, the computer 38 induces the display device 42 to displaythe 3-D model 542 of the anatomical region having the marking icon atthe selected one of the first and second points 552, 554 representingthe location of the point of interest.

At step 526, the computer 38 stores the 3-D model 542 with the markingicon at the selected one of the first and second points 552, 554 in thememory device 40.

Referring to FIGS. 27-31, a flowchart of a method for displaying alocation of electrical activation sites and voltage generation sites ona 3-D model of anatomical region of a person in accordance with anotherexemplary embodiment will now be explained. It should be noted that themethod could be iteratively performed to display locations of aplurality of electrical activation sites on a 3-D model of an anatomicalregion and locations of a plurality of voltage generation sites on a 3-Dmodel of the anatomical region.

At step 570, a user disposes the ablation-mapping catheter 32 at a firstpredetermined position in the heart. The ablation-mapping catheter 32detects an electrical signal in the heart.

At step 572, the ablation-mapping catheter 32 determines a firstamplitude of the electrical signal.

At step 574, the user disposes the reference catheter 34 at a secondpredetermined position in the heart. The reference catheter 34 detectsthe electrical signal in the heart.

At step 576, the fluoroscopy image acquisition system 24 generates afirst 2-D image of the heart when an X-ray source 80 of the fluoroscopyimage acquisition system 24 is disposed at a first position in a 3-Dcoordinate system of the fluoroscopy image acquisition system 24. Thefirst 2-D image indicates the ablation-mapping catheter and thereference catheter in the heart.

At step 578, the computer 38 makes a determination as to whether a userdesires to mark electrical activation sites on a 3-D model. If the valueof step 578 equals “yes”, the method advances to step 580. Otherwise,the method advances to step 610.

At step 580, the computer 38 induces the display device 42 to displaythe first 2-D image. The computer 38 operably communicates with thefluoroscopy image acquisition system 24, the display device 42, and theinput device 44.

At step 582, the user selects a first point on the first 2-D imageutilizing the input device 44 operably communicating with the displaydevice 42. The first point is in a 2-D coordinate system of the first2-D image. The first point corresponds to a portion of theablation-mapping catheter 32 disposed in the heart.

At step 584, the computer 38 determines a first projection lineextending from the first point to the first position of the X-ray source80 in the 3-D coordinate system of the fluoroscopy image acquisitionsystem 24.

At step 586, the fluoroscopy image acquisition system 24 generates asecond 2-D image of the heart when the X-ray source 80 of thefluoroscopy image acquisition system 24 is disposed at a second positionin the 3-D coordinate system of the fluoroscopy image acquisition system24. The second 2-D image indicates the ablation-mapping catheter 32 andthe reference catheter 34 in the heart.

At step 588, the computer 38 induces the display device 42 to displaythe second 2-D image.

At step 590, the user selects a second point on the second 2-D imageutilizing the input device 44. The second point is in a 2-D coordinatesystem of the second 2-D image. The second point corresponds to aportion of the ablation-mapping catheter 32 disposed in the heart.

At step 592, the computer 38 determines a second projection lineextending from the second point to the second position of the X-raysource 80 in the 3-D coordinate system of the fluoroscopy imageacquisition system 24.

At step 594, the computer 38 determines a first point of interest in thecoordinate system of the fluoroscopy image acquisition system 24 thatcorresponds to an intersection point of the first and second projectionlines.

At step 596, the computer 38 determines a position of the first point ofinterest in a 3-D coordinate system of a 3-D model of the heart,utilizing a transformation matrix. The point of interest is a locationof a portion of the ablation-mapping catheter 32.

At step 598, the computer 38 determines a first time that theablation-mapping catheter 32 receives the electrical signal from theheart. The computer 38 operably communicates with the ablation-mappingcatheter 32, the reference catheter 34, and the fluoroscopy imageacquisition system 24.

At step 600, the computer 38 determines a second time that theablation-mapping catheter 32 receives the electrical signal from theheart.

At step 602, the computer 38 determines a first time difference betweenthe first and second times.

At step 604, the computer 38 attaches a first marking icon at the firstpoint of interest in the 3-D model of the heart indicating the firsttime difference.

At step 606, computer 38 induces the display device 42 to display the3-D model of the heart having the marking icon at the point of interestindicating the first time difference.

At step 608, the computer 38 stores the 3-D model with the first markingicon in the memory device 40. After step 608, the method advances tostep 610.

At step 610, the computer 38 makes a determination as to whether theuser desires to mark voltage generation sites on a 3-D model. If thevalue of step 610 equals “yes”, the method advances to step 612.Otherwise, the method returns to step 576.

At step 612, the fluoroscopy image acquisition system 24 generates athird 2-D image of the heart when an X-ray source 80 of the fluoroscopyimage acquisition system 24 is disposed at a third position in a 3-Dcoordinate system of the fluoroscopy image acquisition system 24. Thethird 2-D image indicates the ablation-mapping catheter 32 and thereference catheter 34 in the anatomical region.

At step 614, the computer 38 induces the display device to display thethird 2-D image.

At step 616, the user selects a third point on the third 2-D imageutilizing the input device 44 operably communicating with the displaydevice 42. The third point is in a 2-D coordinate system of the third2-D image. The third point corresponds to a portion of theablation-mapping catheter 32 disposed in the heart.

At step 618, the computer 38 determines a third projection lineextending from the third point to the third position of the X-ray source80 in the 3-D coordinate system of the fluoroscopy image acquisitionsystem 24.

At step 620, the fluoroscopy image acquisition system 24 generates afourth 2-D image of the heart when the X-ray source 80 of thefluoroscopy image acquisition system 24 is disposed at a fourth positionin the 3-D coordinate system of the fluoroscopy image acquisition system24. The fourth 2-D image indicates the ablation-mapping catheter 32 andthe reference catheter 34 in the heart.

At step 622, the computer 38 induces the display device 42 to displaythe fourth 2-D image.

At step 624, the user selects a fourth point on the fourth 2-D imageutilizing the input device 44. The fourth point is in a 2-D coordinatesystem of the fourth 2-D image. The fourth point corresponds to aportion of the ablation-mapping catheter 32 disposed in the heart.

At step 626, the computer 38 determines a fourth projection lineextending from the fourth point to the fourth position of the X-raysource 80 in the 3-D coordinate system of the fluoroscopy imageacquisition system 24.

At step 628, the computer 38 determines a second point of interest inthe coordinate system of the fluoroscopy image acquisition system 24that corresponds to an intersection point of the third and fourth andsecond projection lines.

At step 630, the computer 38 determines a position of the second pointof interest in the 3-D coordinate system of the 3-D model of the heart,utilizing a transformation matrix. The point of interest is a locationof a portion of the ablation-mapping catheter 32.

At step 632, the computer 38 attaches a second marking icon at thesecond point of interest in the 3-D model of the heart indicating thefirst amplitude of the electrical signal.

At step 634, the computer 38 induces the display device 42 to displaythe 3-D model of the heart having the second marking icon at the secondpoint of interest.

At step 636 the computer 38 stores the 3-D model with the second markingicon in the memory device 40.

Referring to FIG. 32, a graphical user interface 650 that is utilized toallow a user to view 2-images of anatomical regions, 3-D models ofanatomical regions, and registered images of the anatomical regions isillustrated. The computer 38 can induce the display device 42 to displaythe graphical user interface 650. The graphical user interface 650 isalso utilized to allow the user to select points on 2-D images ofanatomical regions for determining points of interest on 3-D models andregistered images of anatomical regions. In particular, the graphicaluser interface 650 allows a user to select points of interestcorresponding to ablation points on a heart. As shown, the graphicaluser interface 650 includes a user icon 652 entitled “Ablation Points.”When a user selects the user icon 652, a control panel 654 is displayed.The control panel 654 allows a user to select a plurality of ablationpoints 660 on the image 670.

Referring to FIG. 33, a registered image 680 having an antero-posteriorview of the heart is illustrated. The registered image 680 furtherincludes marking icons indicating positions of activation sites on aheart where the ablation-mapping catheter 32 measured an electricalsignal in the heart. For example, the marking icon 682 having associatedinformation “−150 ms” indicates that the ablation-mapping catheter 32measured an electrical signal 150 milliseconds after the referencecatheter 34 measured the electrical signal at a location in the heartcorresponding to the location of the marking icon 682. Referring to FIG.34, a registered image 690 having an anterior oblique view of the heartis illustrated. The registered image 690 further includes marking iconsindicating positions of activation sites on the heart where theablation-mapping catheter 32 measured electrical signals in the heart.

Referring to FIG. 35, a registered image 700 having an antero-posteriorview of the heart is illustrated. The registered image 700 furtherincludes marking icons indicating positions of voltage generation siteson a heart where the ablation-mapping catheter 32 measured an amplitudeof an electrical signal in the heart. For example, the marking icon 710having associated information “1.5 mV” indicates that theablation-mapping catheter 32 measured an electrical signal having anamplitude of 1.5 millivolts at the location in the heart identified bythe marking icon 710.

The method for generating a registered image relative to a cardiac cycleand a respiratory cycle of a person represents a substantial advantageover other methods. In particular, the method provides a technicaleffect of generating a registered image of an anatomical region,utilizing a 2-D image and a 3-D model both representing at least aportion of the anatomical region at a predetermined phase of a cardiaccycle and a predetermined phase of a respiratory cycle.

While embodiments of the invention are described with reference to theexemplary embodiments, it will be understood by those skilled in the artthat various changes may be made and equivalence may be substituted forelements thereof without departing from the scope of the invention. Inaddition, many modifications may be made to the teachings of theinvention to adapt to a particular situation without departing from thescope thereof. Therefore, it is intended that the invention not belimited to the embodiment disclosed for carrying out this invention, butthat the invention includes all embodiments falling with the scope ofthe intended claims. Moreover, the use of the terms first, second, etc.does not denote any order of importance, but rather the terms first,second, etc. are used to distinguish one element from another.Furthermore, the use of the terms a, an, etc. do not denote a limitationof quantity, but rather denote the presence of at least one of thereferenced items.

1. A method for obtaining a registered image of an anatomical region ofa person relative to a cardiac cycle and a respiratory cycle of theperson, comprising: generating a plurality of 2-D images of theanatomical region; generating a 3-D model of the anatomical region ofthe person, the 3-D model being associated with a predetermined phase ofthe cardiac cycle and a predetermined phase of the respiratory cycle;selecting a first 2-D image from the plurality of 2-D images associatedwith the predetermined phase of the cardiac cycle and the predeterminedphase of the respiratory cycle; generating the registered image of theanatomical region utilizing the first 2-D image and the 3-D model; andstoring the registered image of the anatomical region in a memorydevice.
 2. The method of claim 1, wherein the anatomical region is aregion of a heart.
 3. The method of claim 1, further comprisingmonitoring the respiratory cycle of the person utilizing a respiratorymonitoring system.
 4. The method of claim 3, further comprisingdetermining phases of the respiratory cycle utilizing positions of acatheter in the plurality of 2-D images, utilizing the respiratorymonitoring system.
 5. A system for obtaining a registered image of ananatomical region of a person relative to a cardiac cycle and arespiratory cycle of the person, comprising: a fluoroscopy imageacquisition system configured to generate a plurality of 2-D images ofthe anatomical region; a CT image acquisition system configured togenerate a 3-D model of the anatomical region of the person, the 3-Dmodel being associated with a predetermined phase of the cardiac cycleand a predetermined phase of the respiratory cycle; a computerconfigured to select a first 2-D image from the plurality of 2-D imagesassociated with the predetermined phase of the cardiac cycle and thepredetermined phase of the respiratory cycle; the computer furtherconfigured to generate the registered image of the anatomical regionutilizing the first 2-D image and the 3-D model; and the computerfurther configured to store the registered image of the anatomicalregion in a memory device.
 6. The system of claim 5, wherein theanatomical region is a region of a heart.
 7. The system of claim 5,further comprising a respiratory monitoring system configured to monitorthe respiratory cycle of the person.
 8. The system of claim 7, whereinthe respiratory monitoring system is further configured to determinephases of the respiratory cycle utilizing positions of a catheter in theplurality of 2-D images.